Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium.

BACKGROUND: Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS: Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS: A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS: Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER: NCT04354701.

High mortality among hospital-acquiredCOVID-19 infection in patients with cancer: Anobservational cohort study from Quebec and British Columbia

Background: Studies suggest that patients with cancer are more likely to experience severe outcomes fromCOVID-19. Therefore, cancer centers have undertaken efforts to care for patients with cancer in COVID-free zones.Nevertheless, nosocomial transmission of COVID-19 in patients with cancer likely occurs, but the frequency andrelevance of these events remain unknown. The goal of this study was to determine the incidence and impact ofhospital-acquired COVID-19 in this population and identify prognostic factors for COVID-19 severity in patients withcancer. Methods: Patients with cancer and a laboratory-confirmed or presumed diagnosis of COVID-19 were prospectivelyidentified using provincial registries and hospital databases between March 3rd and May 23rd, 2020, in theprovinces of Quebec and British Columbia. Patients' baseline characteristics including age, sex, comorbidities, cancer type, and type of anticancer treatment were collected. The primary outcome was incidence of hospital-acquired infection defined by diagnosis of SARS-CoV-2 5 days after hospital admission for COVID-unrelated cause. Co-primary outcomes were death or composite outcomes of severe illness from COVID-19 such as hospitalization, supplemental oxygen, intensive-care unit (ICU) admission, and/or mechanical ventilation. Results: A total of 253 patients (N=250 adult and N=3 pediatric) with COVID-19 and cancer were identified, and themajority were residents of Quebec (N=236). Ninety patients (35.6%) received active anticancer treatment in the last3 months prior to COVID-19 diagnosis. During a median follow-up of 23 days, 209 (82.6%) required hospitalization,38 (15%) required admission to ICU, and 71 (28%) died. Forty-seven (19%) had a diagnosis of hospital-acquiredCOVID-19. Median overall survival was shorter in those with hospital-acquired infection, compared to acontemporary community-acquired population (27 days vs. 71 days, HR 2.2, 95% CI 1.2-4.0, p=0.002). Multivariateanalysis demonstrated that hospital-acquired COVID-19, age, ECOG status, and advanced stage of cancer wereindependently associated with death. Conclusion: Our study demonstrates a high rate of nosocomial transmission of COVID-19, associated withincreased mortality in both univariate and multivariate analysis in the cancer population, reinforcing the importanceof treating patients with cancer in COVID-free zones. We also validated that age, poor ECOG, and advanced cancer were negative prognostic factors for COVID-19 in patients with cancer.

Changes in lung cancer treatment as aresult of the COVID19 pandemic: A prospectiveobservational study

Background: Patients with lung cancer are at high risk from COVID19. Efforts are ongoing to limit exposure ofpatients with lung cancer to the health care system. As a result, the COVID19 pandemic has drastically changedcancer care, but the extent and type of these changes are unknown. The goal of this study was to evaluate thechanges in lung cancer treatment during the peak of the COVID19 pandemic. Methods: We prospectively assessed the cancer management plan of all patients seen in the thoracic oncologyclinic at our center between March 2 and April 30, 2020. Inclusion criteria for this study were a diagnosis of eithernon-small cell lung cancer or small-cell lung cancer. Those who had a diagnosis of COVID19 were excluded fromthe study. Primary endpoints were to describe the extent of changes in the cancer treatment plan and qualify thetypes of changes observed. Results: A total of N=289 patients were evaluated between March 2 and April 30, 2020. N=14 patients wereexcluded due to presence of other tumor histology, and 2 patients were COVID19-positive. Among the 275 patientsincluded, median age was 68 and 47% were male. Among the 238 patients (86.5%) with non-small cell lung cancer,172 (62.5%) had advanced disease. Among the 37 patients (13.5%) with small-cell lung cancer, 11 (4%) hadextensive disease. 211 were receiving active treatment (76.5%), with 35.1% on chemotherapy, 21.8% on oralagents, 31.8% on immune checkpoint inhibitors, and 11.4% on combination therapy. 121 (57%) of patientsexperienced at least one change in their lung cancer treatment plan as a direct result of the COVID19 pandemic, with 19 (9.0%) patients experiencing more than one change. The majority of changes encompassed delay orcessation of palliative treatment, N=48 (39.7%), N=18 (14.9%), respectively. Mean time to resumption of palliativetreatment was 36 days, and 3% of patients stopped palliative treatment permanently as a direct result of thepandemic. Changes in dosing and schedule occurred in N=32 (26.4%), which included changing pembrolizumab toq 6 weeks or durvalumab to q 4 weeks. A minority of patients experienced delays in adjuvant chemotherapyadministration (N=3 (2.5%)) with a mean delay of 42 days. Lastly, 6.6% of patients experienced deferrals orcancellations of surveillance scans or visits due to COVID19. Other changes included the decision not to pursuepalliative chemotherapy. Conclusion: Our study demonstrated that a significant proportion (57%) of patients experienced changes in theirlung cancer management plan as a direct result of the COVID19 pandemic. Given the preliminary findings thatactive cancer treatment is not associated with increased complications from COVID19, lung cancer treatments andsurveillance visits should continue to proceed with caution, and oncology care providers should continue to carefullyproceed with evidence-based care in lung cancer.